老年胃癌患者术前衰弱与代谢综合征的临床特征及相关性研究  

Clinical Characteristics and Correlation between Preoperative Frailty and Metabolic Syndrome among Older Patients with Gastric Cancer

作　　者：蒋小曼 徐欣怡 丁玲玉 郭银宁 缪雪怡 陈丽 许勤[1] JIANG Xiaoman;XU Xinyi;DING Lingyu;GUO Yinning;MIAO Xueyi;CHEN Li;XU Qin(School of Nursing,Nanjing Medical University,Nanjing 211166,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Faculty of Health,Queensland University of Technology,Brisbane 4702,Australia;Department of General Surgery,Jiangsu Province Hospital/The First Affiliated Hospital with Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]南京医科大学护理学院,江苏省南京市211166 [2]浙江大学医学院附属第一医院胃肠外科,浙江省杭州市310003 [3]昆士兰科技大学健康学院,澳大利亚布里斯班4702 [4]江苏省人民医院南京医科大学第一附属医院普外科,江苏省南京市211166

出　　处：《中国全科医学》2025年第17期2134-2141,2148,共9页Chinese General Practice

基　　金：国家自然科学基金面上项目(82073407);江苏高校优势学科建设工程项目“护理学”(苏政办发[2018]87号)。

摘　　要：背景衰弱与代谢综合征(MetS)均是常见的老年综合征,两者在发生风险、身体成分以及代谢机制等多个层面均具有潜在重要联系,可共同影响老年胃癌患者预后。明确区分两者特征并阐明内在联系有助于制定精准、针对性的术前管理措施。目的比较老年胃癌患者术前衰弱与MetS在一般资料、血液检测及身体成分等临床指标的特征,并分析两者间相关性。方法连续性纳入2021年8月—2022年8月于江苏省人民医院胃外病区因诊断为胃部恶性肿瘤入院的60~80周岁老年患者286例。根据衰弱及MetS发生情况分为:衰弱组45例,MetS组58例,衰弱+MetS组12例,正常组171例。比较4组患者临床指标特征。采用Logistic回归分析探讨老年胃癌患者MetS及其诊断指标与术前衰弱的相关性。结果4组年龄、合并症、营养风险筛查2002(NRS2002)评分>3分所占比例、空腹血糖、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、C反应蛋白、血红蛋白、白蛋白、身高、体质量、腰围、BMI、脂肪含量、脂肪质量指数、体脂率、内脏脂肪面积、骨骼肌含量、骨骼肌质量指数、四肢骨骼肌质量指数、肌肉率、脂肪肌肉比、肌脂比比较,差异均有统计学意义(P<0.05)。多因素Logistic分析结果显示,年龄(OR=1.115,95%CI=1.046~1.190)、吸烟史(OR=2.156,95%CI=1.134~4.096)、NRS2002评分>3分(OR=2.359,95%CI=1.159~4.802)、C反应蛋白(OR=1.038,95%CI=1.003~1.073)、中心性肥胖(OR=0.405,95%CI=0.183~0.896)是老年胃癌患者衰弱的影响因素(P<0.05)。结论衰弱组呈现高龄、炎症水平升高、营养风险增加等特征,并且伴随脂肪和肌肉成分整体下降的消瘦状态;MetS组以合并症增加、炎症水平升高、白蛋白升高、糖脂代谢指标异常以及脂肪和肌肉成分整体增加为特征;衰弱合并MetS组以合并症增加、空腹血糖及HDL-C异常为特征,并且脂肪相关成分升高,肌肉成分无明显变化。在本研究人�Background Frailty and metabolic syndrome(MetS)are both common geriatric conditions and may have potentially important links in terms of risk factors,body composition and metabolic mechanisms,which could jointly affect the prognosis of older patients with gastric cancer.Clearly distinguishing the characteristics of the two syndromes and elucidating their intrinsic relationship can help to develop precise and targeted preoperative management strategies.Objective To compare the characteristics of preoperative frailty and MetS in older patients with gastric cancer,focusing on general information,blood indicators and body compositions,then analyze their correlation.Methods A total of 286 patients aged 60 to 80 years who were admitted to the Gastrosurgery Department of the Jiangsu Province Hospital for gastric malignancy from August 2021 to August 2022 were included and divided into the four groups:the frailty group(n=45),the MetS group(n=58),the frailty+MetS group(n=12)and the normal group(n=171)based on the presence of frailty and MetS,and the clinical indicators of these groups were compared.With frailty as the dependent variable,Logistic regression analysis was conducted to investigate the correlation of MetS and the diagnostic indicators with preoperative frailty.Results Statistically significant differences were observed among the four groups in terms of age,comorbidities,Nutritional Risk Screening 2002(NRS2002)scores>3,fasting blood glucose,triglyceride,high-density lipoprotein cholesterol(HDL-C),C-reactive protein(CRP),hemoglobin,albumin,height,body mass,waist circumference,BMI,fat content,fat mass index,body fat percentage,visceral fat area,skeletal muscle content,skeletal muscle mass index,limb skeletal muscle mass index,muscle percentage,fat to muscle ratio and muscle to fat ratio(P<0.05).Multivariate Logistic regression analysis showed that age(OR=1.115,95%CI=1.046-1.190),history of smoking(OR=2.156,95%CI=1.134-4.096),NRS2002 score>3(OR=2.359,95%CI=1.159-4.802),CRP(OR=1.038,95%CI=1.003-1.073)and central ob

关 键 词：胃肿瘤 衰弱 代谢综合征 老年人 临床特征 相关性 

分 类 号：R735.2[医药卫生—肿瘤]